- Retching, vomiting and restlessness

- shivering, rigidity and slight cyanosis 

(caused by change in body temperature)

- Nitrous oxide

- Fluothane

-Ethrane

(Nitrous oxide is obvious, the other 2 end in "ane")

- Pentothal

- Ketamine

-Diprivan 

- Respiratory depression

- Hypotension

- Bradycardia

-N/V

- Dry mouth

- Overdose

-unrecognized hypoventilation

- complications of intubation

- malignant hyperthermia

Early signs = tachycardia, dysrhytmias, muscle rigidity, hypotension, cyanosis, muscle protein in urine, rise in end tidal CO2 level, low O2 sats

Late signs = extremely high temperature up to 110 degrees F

- local anesthesia 

- injecting into subarachnoid space

- probably want to keep HOB flat to prevent spinal headaches 

- possibility of allergies and toxicity (rare)

- diminished sensation 

- diminished motor response

-hypotension 

- injecting gas or air into body cavity to seperate organs and improve visualization 

- may contribute to complications and pt. discomfort 

- most controllable method

- induction and reversal accomplished with pulmonary ventilation

- few side effects

- must be used in combination with other agents for painful or prolonged procedures

- limited muscle relaxant effects

- post-op nausea and shivering are common

- explosive 

- rapid and pleasant induction

- low incidence of post-op N/V

-requires little equipment

- must be metabolized and excreted from the body for complete reversal

- contraindicated with hepatic or renal disease

- retained by fat cells 

- gag and cough reflexes intact

- cooperation/particpation by pt.

- less disruption of physical emotional body functions

- decrased chance of sensitivity to agent

-decreased intra-op stress

- difficult to give to uncooroperative pt.

- not way to control agent after adminster

-absorbs rapidly into blood causing hypotension or overdose

Dantrolene Sodium

(skeletal muscle relaxant)

Risk for perio-op positioning injury

Risk for infection 

- COPD

- Obese patients

-Asthmatics

- Smokers

- elderly 

- Tachycardia

-Tachypnea

- Dyspnea

- increased agitation

-restlessness

-anxiety 

- Diaphoresis

-retractions

-altered LOC

- With kids: nasal flaring, grunting, stridor, feeding problems

- increased restlessness

-somnolence

-stupor

-dyspnea

-Bradycardia

-cyanosis 

- shock

-cardiac problems

-increased metabolic rate

-pain 

Airway obstruction:

- tracheal or laryngeal spasm

-mucus in airway

-blockage from edema or tongue relaxation 

- when changes are 25% higher or lower than baseline

- report to anesthesia provider or surgeon 

- an anesthesia effect

-hypothermia 

- hemorrhage

-shock

-pain 

- muscular irritability 

- restlessness and delirium

-recognition of pain

-ability to reason and control behavior 

- sense of touch

-sense of pain

-sense of warmth

-sense of cold

-ability to move

- hypovolemia 

-renal complications 

-few or absent bowel sounds

-distended abdomen

-abdominal discomfort

-vomiting

- no passage of flatus or stool 

- impaired gas exchange

-impaired skin integrity

-acute pain 

- call for help (help should call doctor)

-cover with sterile saline soaked gauze

-assess for shock

-pt. in supine w/ hips and knees bent

-HOB 15-20 

-vital signs

-prep for surgery 

- morphine

-meperidine

-hydromorphone 

- Fentanyl (sublimaze)

- Duramorph

-bupivacaine (Marcaine)

- secure airway and IV access

-preapre to administer flumazenil

-repeat drug q 2-3 min

-give O2 if hypoxic or below 10/min

-have suction ready 

-skin rash

-hot flashes

-dizziness

-headache

-sweating

-dry mouth

-blurred vision 

RLQ between iliac crest and umbilus 

(where pain usually is as inflammation and infectin progress in appendicitis)

WBC count greater than 20K may indicate

(r/t appendicitis)

- NPO

-IV fluids

-Semi-fowlers

-Once confirmed admin. opiod analgesics and antibiotics 

-typicall none in early stages 

-urinary frequency

-impotence

-pain

-weakness/numbness

-loss of bladder and bowel control

-Hematuria (later sign)

- reduced/loss of libido

-breast tendernes and growth

-elevated cholesterol

-decreased mental acuity

-impotence 

-anemia

- decreased muscle mass

-osteoporosis 

-hot flashes

-weight gain

-fatigue 

-depression 

-fatigue

-loss of appetite

-N/V

-Hair loss

-mouth sores

-anemia

-decreased WBC count (risk for infection)

-low platelets (easy brusing and bleeding)

-rectal bleeding

-anemia

-change in stool 

- H&H usually decreased

-fecal occult blood test postive

**a negative does NOT mean colon cancer is not present**

- possible elevation of carcinoembryonic antigen

-Intussuception

-Volvolus 

- paralytic ileus

-adynamic ileus 

- midabdominbal pain/cramping

-vomiting

-obstipation (no stool)

-Diarrhea

-alteration in bowel pattern

-abdominal distention

-Borborygmi (rumbling or gurgling sounds)

-abdominal tenderness 

- constant, diffuse discomfort

-abdominal distention

-decreased/absent bowel sounds

-vomiting

-obstipation ( no stool)

-electrolyte imabalance 

- inflammation of common bile duct

-complication of cholecystitis 

-acute pain

-risk for infection

-impaired gas exchange

-nausea

-imbalanced nutrition

-fluid and electrolyte imbalances

-activity intolerance

-risk for anxiety 

- pregnancy

-structural defects (reflux)

-obstruction

-diabetes 

-fever

-chills

-flank, back, loin pain

-burning, urgency, frequency, dysuria

-general malaise

-fatigue 

- gets rid of CO2

-motility 

-peristalsis 

-increase circulation 

-Urinalysis (WBCs, protein, bacteria, RBCs)

-urine culture

-KUB

-kidney failure

-sepsis 

- acute pain

- infection/risk for infection

-imbalanced nutrition

-risk for fluid volume excess/deficit

-deficient knowledge 

-IV antibiotics

-hydration

-nutrition

-cranberry juice 

When you have stones and inflammation

(most common type)

-RUQ pain (usually severe and comes and goes)

-Murphys sign (pain with deep breath)

-Bloomburgs sign (rebound pain)

-pain after eating (food not being digested)

-N/V

-Dyspepsia 

-Flatulence

-fever (because of inflammation)

-Jaundice (obstructive)

-itching or burning of skin due to toxic accumulatio of bile salts

-clay colored stools

-dark urine

-steatorrhea (fatty stools)

-female

-fertile

-fat

-forty 

- women (20-60 yrs)

-multiple pregnancies 

-estrogen

- >60 years

-obesity

-family hx (eat same foods)

- Diabetes (increased triglycerides)

-The four F's

-American indian, Mexican, caucasian 

-HTN

-Nocturia

-fluid and electrolyte imbalance

-possible hyperkalemia 

-BUN and Creatinine are elevated

(normal BUN = 6-20, normal creatinine = 0.6-1.1)

-Urinalysis (bacteria, protein, blood)

-GFR (normal is 90-120mL/min)

anything < 60 is r/t kidney disease

anything < 15 is kidney failure 

-Biopsy 

-steptococcal infection

-systemic lupus erythematosus

-diabetic nephropathy (nephrons get hard and don't function properly)

-fluid volume excess

-acute/chronic pain

-risk for imbalanced nutrition (less than)

-anxiety

-infection/risk for infection 

Prostate cancer is ____1_____ growing and _______2_____ in a _________3_________

pattern.

1. slow

2. metastasizes

3. predictable 

-difficulty in starting urination

-frequent bladder infections

-urinary retention 

-edema (especially periorbital and facial)

-dark and cloudy urine

-increased B/P

-fatigue

-flank pain, back pain

-proteinuria

-hematuria

-decreased glomerular filtration 

Transurethral resection of the prostate

(not curative treatment)

- MIS

-patients must have PSA <10 ng/mL and no previous hormone therapy

-is a curative treatment

-may experience temporary ED

-ED

-persistant pain

-hematuria 

-leuprolide (Lupron)

-goserelin (Zoladex)

-triptorelin (Trelstar)

-hot flashes

-ED

-decreased libido

-gynecomastia (breast tenderness and growth)

-flutamide (Eulexin)(Euflex)

-bicalutamide (casodex)

-nilutamide (nilandron)

-MIS

-reserved for those whose cancer is confined to prostate gland

-liquid nitro freezes the gland causing cell death

-high risk for urinary incontinence and ED

-bowel obstruction

-perforation w/ peritonitis

-abcess formation

-fistulas 

Normal PSA level 

(prostate-specific antigen)

- high fat like red meats

-friend and grilled meats and fish

-excess of refined carbs

-decreased fiber 

-fatigue r/t anemia

-abdominal fullness

-vague abdominal pain

-unintentional weight loss

-rectal bleeding

-anemia 

-change in stool

-mid-abdominal pain or cramping

-pain can be sporadic 

-vomiting

-diarrhea (partial obstruction)

-obstipation (complete obstruction)

-WBC normal unless strangulated obstruction

-H&H, creatinine and BUN are elevated indicating dehydration

-serum Na, Cl and K are decreased

-high obstruction mayhave metabolic alkalosis 

-low obstruction may have metabolic acidosis 

-

-episodic or vaque increased abdominal pain or discomfort that can radiate to right shoulder

-pain triggered by fatty or high volume meal

-anorexia

-N/V 

-dyspepsia

-Eructation (belching)

-gas

-fullness

-rebound tenderness

-fever

-jaundice, clay colored stools and dark urine are most common with chronic 

-fever

-chills

-N/V

-tachycardia and tachypnea

-flank, back or loin pain

-tender costal vertebral angle

-abdominal, often colicky discomfort

-general malaise or fatigue

-burning, urgency or frequency

-nocturia 

-HTN

-inability to conserve Na

-decreased urine concentrating ability 

-tendency to develop hyperkalemia and acidosis 

ureter repair or revision

(for pt's with poor ureter valve closure or dilated ureters)

-proteinuria

-hematuria

-decreased GFR

-edema

-HTN

-edema in face, eyelids, hands and other parts of body

-fluid overload

-SOB

-crackles, neck vein distention

-hematuria

-fatigue, anorexia, N/V

(may be confused with congestive heart failure, especially in older adults)

-widespread inflammation of mainly the rectum and rectosigmoid colon, but can spread to entire colon

-In mild cases the intestinal mucosa is hyperemic (increased blood flow), edematous and reddened 

-In severe cases the lining can bleed and small ulcers can occur 

-stool contains blood and mucus

-tenesmus (unpleasant and urgent sensation to defecate)

-abdominal colicky pain (relieved with defecation)

-malaise, anorexia, weight loss 

- risk is 10 times greater when first degree relative has it

-peak age @ 20-40 and again at 55-65

- women more often in younger years, but same as men in older years

-those who don't smoke have increased risk 

-hemorrhage/perforation

-abcess formation

-toxic megacolon

-malabsorption

-non-mechanical obstruction

-fistulas

-colorectal cancer

-extraintestinal complications

-osteoporosis 

-vital signs usually WNLs with mild disease

-with severe disease there may be a low grade fever

-physical assessmet findings are usually non-specific and in milder cases the exam may be normal 

-Diarrhea

-Acute/Chronic pain 

-aminosalicylates

-glucocorticoids

-immunomodulators

-anti-diarrheal drugs 

-colectomy (colon removal) and ileostomy

indications for surgery include, perforation, toxic megacolon, hemorrhage, dysplastic biopsy results, failure of conventional treatment and colon cancer

-inflammatory of small intestine, colon or both

-skip lesions

-all layers are affected

-severe diarrhea and malabsorption

-fistula formation

-occurs in adolescents or young adults 

-N/V

-abdominal pain

-anorexia

-rebound pain

-with perforation there is an increase in pain with coughing or movement and relieved by bending right hip or knee and increased temperature 

-NPO

-IVF

-semi-fowlers

-no smoking or gum

- never use enemas, laxatives or heat

Potassium

-hyperkalemia increases the risk for dysrhytmias

-Hypokalemia increases cardiac irritability and increases recovery time from anesthesia 

Normal = 3.5-5

Increased in - dehydration, renal failure, acidiosis, cellular tissue damage

decreased in - NPO status when K supplement isn't adequate, excessive use of diuretics, vomiting, malnutrition, diarrhea and alkalosis 

Normal = 135-145

increased in - cardiac or renal failure, HTN, increased use of normal saline, edema, dehydration 

decreased in - NG drainage, vomiting or diarrhea, excessive use of laxatives or diuretics, increased IVF using water 

normal = 98-106

increased in - respiratory alkalosis, dehydration, renal failure, increased use of IVF using NaCl

decreased in - increased NG drainage, vomiting, excessive use of diuretics, diarrhea 

normal = 23-30

increased in - chronic pulmonary disease, intestinal obstruction, vomiting, or NG suction, metabolic alkalosis

decreased in - hyperventilation, diabetic ketoacidosis, diarrhea 

normal = 70-110

increased in - hyperglycemia, increased IVF using glucose, stress, steriod use, pancreatic or hepatic disease

decreased in - hypoglycemia, excessive insulin 

normal = 0.5-1.2

increased in - renal damage, renal insufficiency, acute renal failure, chronic kidney disease and end stage kidney disease

decreased in - atrophy of muscle 

normal = 10-20

increased in - dehydration, renal failure, increased protein in diet, liver failure

decreased in - overhydration, malnutrition 

Increased surgical risk or post-op complications 

(age)

Increased surgical risk or post-op complications

(meds)

-antihypertensive drugs

-tricyclic antidepressants

-anticoagulants

-NSAIDs

- elevated temp.

-very high or very low B/P

-increased HR

-obese

-40+

-have cancer

-immobility 

-spinal cord injury

-Hx of DVT/PE, varicose veins or edema

-oral contraceptives

-smokers

-decreased cardiac ouput

-ortho surgery 

-CAD

-angina

-MI within 6 months

-heart failure

-HTN

-dysrythmias 

-skin breakdown

-delayed wound healing

-possible dehiscence or evisceration 

-dehydration

-sepsis 

-Deficient knowledge

-anxiety 

Cardiopulmonary depression

**monitor airway mangement**

-adequate nutrition and fluid and electrolyte balance

-monitor urinary output

*a decrease indicates possible dehydration

- at least 3000 calories daily to promote healing

-prevent skin irritation from drains 

Peptic ulcer disease 

(PUD)

- gastric

-duodenal

-stress 

-acid

-pepsin

-H. pylori infection 

- upper portion of duodenum (most often)

-high gastric acid secretion 

-pH levels are low (excess acid) in duodenum

-protein rich meals and calcium and vagus nerve excitation stimulate acid secretion 

-upper GI bleed

-bright red or coffee ground vomit

-tarry stools or frank blood in stool

-melena

- decreased B/P

-increased, weak, and thready pulse

-decreased H&H

-vertigo

-acute confusion

-dizziness

-syncope

-hemorrhage

-perforation 

-pyloric obstruction

-intractable disease 

bleeding at or above the duodenoljejunal junction 

(upper GI bleeding)

-epigastric tenderness

-initially hyperactive bowel sounds that may diminish with progression

-dyspepsia (most common reported sign)

-abdominal pressure or fullness or hunger

-gastric ulcer pain = upper epigastric and aggravated by food

-duodenal pain = right of epigastric pain and occuring 90min to 3 hrs after eating

- decreased H&H

-positive occult blood 

esophagogastroduodenoscopy

EGD

potential for GI bleeding 

Others: 

potential for shock

potential for metabolic alkalosis 

- provide pain relief 

-eliminate H. pylori infection

-heal ulcerations

-prevent recurrence 

- proton pump inhibitors

-H2-receptor antagonists

-prostaglandin analogues 

- drug class of choice for treating acid r/t disorders

examples: Prilosec, Prevacid, Acipnex, protonix, Nexium 

-block histamine-stimulated gastric secretions

examples: Zantac, Pepcid, Axid 

-effective with duodenal ulcers

-reduce gastric acid secretion 

example: Cytotec 

adverse effect is uterine contraction 

Nutrition therapy for PUD

-bland diets

-avoid caffeine

-avoid all coffee

-avoid bedtime snacks

-avoid alcohol and tobacco 

-buffer gastric acid

-mylanta and Maalox

-take 2 hrs. after meals

-TUMs triggers gastrin release so it's not recommened 

-those with past or present heart failure need to avoid aluminum hydroxide, magnesium hydroxide, sodium bicarbonate, and simethicone combons (Gelusil and Mylanta)

-feeling of fullness, distention, nausea after eating, vomiting undigested food

-restoring fluid and electrolyte balance and decompressing the dilated stomach 

PPI's

(from Lilley book)

-Prevacid, Prilosec, Aciptlex, Protonix and Nexium

- may increase serum levels of diazepam and phenytoin

-take on empty stomach

H-2 receptor antagonists

(from lilley book)

- most popular

-cimetidine, ranitidine, famotidine and nizatidine

(all end in dine)

-should be taken 1-2 hours before antacids

-smoking decreases the effects 

-ulcers in colon and/or rectum

-usually starts in rectum and moves up

-rarely affects small intestine

-only affects mucosa lining

-15-25 yrs of age and 55-65 years of age

-Diarrhea (liquid, runny, bloody) - 20+ stools daily

-lower abdominal pain

-constant need to defecate and pain and burning in rectal area

-blood stools

-malaise

-anorexia

-mild weight loss

- decreased H&H (bloody stools)

- increased WBC (inflammation)

- increased ESR (indicates inflammation)

- decreased electrolytes (diarrhea)

-hypoalbuminemia (undigested food)

-colonscopy = best diagnostic tool 

- hemorrhage (lower GI bleed)

-perforation

-abscess

-colon cancer

**1/3 die of colon cancer

-toxic megacolon

-bowel obstruction

-malabsorption

-extraintestinal problems

*eye disorders, arthritis, etc. 

-diarrhea

-risk for deficient fluid volume

-acute pain/chronic pain

risk for imbalanced nutrition (less than)

-disturbed body image

-electrolyte imbalances

-impaired skin integrity 

-NPO

-TPN

-low fiber diet

-aminosalicylates

(sulfasalazine, mesalamie (ROWASA = enema or supp, ), balsolazide)

-glucocorticoids (predinisone) (need to be on calcium, not for long term use, increases glucose)

-antidiarrheal (Lomotil and Immodium) (for short term use, when used long term = bowel dilation)

-affects usually small intestine but can affect the colon

-affects all layers (transmural)

-skip leasions

-causes bowel to be thick

- 15-40 yrs of age

-severe weight loss

-diarrhea (losse, soft stool, 5-6 stools per day)

-abdominal pain

-fever

-anemia r/t malnutrition 

-decreased folic acid and B12

-decreased albumin

-increased ESR 

-sever malabsorption

-fistulas

-obstructions

-hemorrhage

-peritonitis r/t perforation 

-impaired nutrition (less than)

-acute/chronic pain

-fluid and electrolyte imbalances

-risk for infection

-ineffective coping 

-TPN

-supplements

-low residue (low fiber)

-dyspepsia

-epigastric tenderness

-pain (gastric = 20-30 min after eating, Duodenum = 1-3 hr after eating)

-N/V

**most people ignore symptoms until pain is severe or bleeding occurs**

-hemorrhage

-perforation

-peritonitis 

-fluid/volume loss

-obstruction (rare)

-intractable pain (pain that will not go away)

-bright red (acute) or coffee ground (chronic) vomit

-melena (black tarry stools)

occult blood

-decreased B/P (fluid loss)

-increased pulse (compensation for B/P)

-vertigo

-light headed

-confusion 

-acute pain

-fluid volume deficit (during bleeding)

-N/V

-imbalanced nutrition 

-prevent hypovolemia and shock

-ABC's

-monitor VS

-monitor fluid status

-adminster fluid or blood

-heme test all excretions

-monitor labs

-acid suppression

-antibiotics

-EGD

=insert NGT/GI lavage 

kidney stones

presence of calculi in urinary tract 

- young and middle aged caucasian males

-personal or family hx

-gout

-hyperparathyroidism

-urinary stasis and repeated infections

-loop diuretics, calcium antacids

-colo ingestions or other dark drinks 

-urinary stasis

-urinary retention

-immobility 

-dehydration 

-renal colic

-unbearable pain

-nausea

-vomiting

-pallor

-diaphoresis 

-morphine

-toradol (NSAID)

-antispasmodics (ditropan)

-shock waves

-conscious sedation

-continuous EKG monitoring 

-hydrourter

-shock

-hematuria

-infection

-hydronephrosis

-permanent kidney damage 

-acute pain

-risk for infection

-knowledge deficit

-impaired urinary elimination

-risk for fluid volume deficit

-nausea

BPH

Benign prostatic hyperplasia 

-glandular units in prostate undergo and increase in number of cells, resulting in elargement of prostate gland

-presents around 40 years but some don't show symptoms until about 60 or older 

-hydronephrosis 

-hydroureter

-dilated renal pelvis

-hyperirritability, hypertrophy and development of cellules and diverticula

-urinary retention and reflux 

-impeded outflow of urine 

-5-Alpha reductase inhibitors (Proscar, Advodart)

-Alpha-1-Adrengic blocking agents (Flomax, Uroxatrol)

-alpha blockers (cardura, Hytrin)

-saw palmetto and lycopene (watermelon)

-thermotherapy

-balloon urethroplasty

-intraurethral stents

-frequent sexual intercourse

-avoiding large quantities of fluid in a short period of time

-void as soon as you have the urge 

-enlarged portion of prostate gland is removed

-pt. will have indwelling cath for at least a day

-CBI (continuous bladder irrigation)

-3 way cath with 30-45 mL retention balloon

-traction via taping to abdomen or thigh

-uncomfortable urge to void continuously 

*teach them not to try and void because it will cause spasms*

-antispasmodic and pain meds

-small clots = normal 

-infection

-urinary incontinence

-ED

-post-op bleeding 

-gradual deterioration of function

-may have decrease in firmness of penis and frequency of erections

-may be due to medical reasons 

-inflammation of prostate, urethra or seminal vesicles

-prostatectomy

-pelvic fractures

-lumbar sacral injuries

-parkinson or multiple sclerosis

-diabetes (major cause)

-smoking, alcohol

-antihypertensive drugs 

-sukdebafil  (Viagra)

-vardenafil (Levitra)

-tadalafil (cialis)

(all end in fil)

-avoid alcohol before sexual intercourse

-common side effects include headaches, facial flushing and stuffy nose

-nitrates + ED drugs = HTN and decreased blood flow to vital organs 

-caverject

-paverine

-regitine

-disturbed body image

-sexual dysfunction

-risk for injury

risk for situational low self-esteem

-deficient knowledge 

-thiazide diurectics (Diuril or HydroDIURIL)

-orthophosphate

-sodium cellulose phosphate 

-First sign may be restlessness

-increased B/P and anxiety are early signs

- difficult to arouse

- decreased B/P

-little urine output

-labored respirations 

-Hx of motion sickness

-obese (fat cells retain anesthesia)

-Pt's with abdominal surgeries 

*usually happens around 5-10 days post-op*

1. call for help (they call doctor)

2. cover with sterile saline soaked gauze

3. HOB 10-15 degrees with hips and kneeds bent

4. assess for shock

5. vital signs

6. do not attempt to put organs back inside

7. prep for surgery

8. document